1,664 results on '"Preoperative Care standards"'
Search Results
2. Developing Quality Measures for Improving Pre-Liver Transplant Care.
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- Humans, Preoperative Care standards, Preoperative Care methods, Quality Improvement, Quality Indicators, Health Care, Liver Transplantation standards
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- 2024
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3. Factors affecting adherence to recommendations on pre-operative cardiac testing: A cohort study.
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Stroda A, Sulot T, Roth S, M'Pembele R, Mauermann E, Ionescu D, Szczeklik W, De Hert S, Filipovic M, Beck Schimmer B, Spadaro S, Matute P, Turhan SC, van Waes J, Lagarto F, Theodoraki K, Gupta A, Gillmann HJ, Guzzetti L, Kotfis K, Larmann J, Corneci D, Howell SJ, and Lurati Buse G
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- Humans, Male, Female, Aged, Middle Aged, Prospective Studies, Cohort Studies, Europe, Echocardiography, Stress, Echocardiography standards, Practice Guidelines as Topic, Risk Assessment methods, Cardiovascular Diseases diagnosis, Aged, 80 and over, Guideline Adherence, Preoperative Care methods, Preoperative Care standards
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Background: Cardiac risk evaluation prior to noncardiac surgery is fundamental to tailor peri-operative management to patient's estimated risk. Data on the degree of adherence to guidelines in patients at cardiovascular risk in Europe and factors influencing adherence are underexplored., Objectives: The aim of this analysis was to describe the degree of adherence to [2014 European Society of Cardiology (ESC)/European Society of Anaesthesiology (ESA) guidelines] recommendations on rest echocardiography [transthoracic echocardiography (TTE)] and to stress imaging prior to noncardiac surgery in a large European sample and to assess factors potentially affecting adherence., Design: Secondary analysis of a multicentre, international, prospective cohort study (MET-REPAIR)., Setting: Twenty-five European centres of all levels of care that enrolled patients between 2017 and 2020., Patients: With elevated cardiovascular risk undergoing in-hospital elective, noncardiac surgery., Main Outcome Measures: (Non)adherence to each pre-operative TTE and stress imaging recommendations classified as guideline-adherent, overuse and underuse. We performed descriptive analysis. To explore the impact of patients' sex, age, geographical region, and hospital teaching status, we conducted multivariate multinominal regression analysis., Results: Out of 15 983 patients, 15 529 were analysed (61% men, mean age 72 ± 8 years). Overuse (conduction in spite of class III) and underuse (nonconduction in spite of class I recommendation) for pre-operative TTE amounted to 16.6% (2542/15 344) and 6.6% (1015/15 344), respectively. Stress imaging overuse and underuse amounted to 1.7% (241/14 202) and 0.4% (52/14 202) respectively. Male sex, some age categories and some geographical regions were significantly associated with TTE overuse. Male sex and some regions were also associated with TTE underuse. Age and regions were associated with overuse of stress imaging. Male sex, age, and some regions were associated with stress imaging underuse., Conclusion: Adherence to pre-operative stress imaging recommendation was high. In contrast, adherence to TTE recommendations was moderate. Both patients' and geographical factors affected adherence to joint ESC/ESA guidelines., Trial Registration: NCT03016936., (Copyright © 2024 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.)
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- 2024
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4. Implementation of a software-based decision support tool for guideline-appropriate preoperative evaluation: a prospective agreement study.
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Kagerbauer SM, Wißler J, Andonov DI, Ulm B, Schneider G, Podtschaske AH, Blobner M, and Jungwirth B
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- Humans, Prospective Studies, Middle Aged, Male, Female, Aged, Adult, Software, Elective Surgical Procedures standards, Decision Support Systems, Clinical, Cross-Over Studies, Practice Guidelines as Topic, Decision Support Techniques, Germany, Guideline Adherence, Preoperative Care methods, Preoperative Care standards
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Background: Guideline adherence in the medical field leaves room for improvement. Digitalised decision support helps improve compliance. However, the complex nature of the guidelines makes implementation in clinical practice difficult., Methods: This single-centre prospective study included 204 adult ASA physical status 3-4 patients undergoing elective noncardiac surgery at a German university hospital. Agreement of clearance for surgery between a guideline expert and a digital guideline support tool was investigated. The decision made by the on-duty anaesthetists (standard approach) was assessed for agreement with the expert in a cross-over design. The main outcome was the level of agreement between digital guideline support and the expert., Results: The digital guideline support approach cleared 18.1% of the patients for surgery, the standard approach cleared 74.0%, and the expert approach cleared 47.5%. Agreement of the expert decision with digital guideline support (66.7%) and the standard approach (67.6%) was fair (Cohen's kappa 0.37 [interquartile range 0.26-0.48] vs 0.31 [0.21-0.42], P=0.6). Taking the expert decision as a benchmark, correct clearance using digital guideline support was 50.5%, and correct clearance using the standard approach was 44.6%. Digital guideline support incorrectly asked for additional examinations in 31.4% of the patients, whereas the standard approach did not consider conditions that would have justified additional examinations before surgery in 29.4%., Conclusions: Strict guideline adherence for clearance for surgery through digitalised decision support inadequately considered patients, clinical context. Vague formulations, weak recommendations, and low-quality evidence complicate guideline translation into explicit rules., Clinical Trial Registration: NCT04058769., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)
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- 2024
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5. Evaluating the accuracy of ChatGPT-4 in predicting ASA scores: A prospective multicentric study ChatGPT-4 in ASA score prediction.
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Turan Eİ, Baydemir AE, Özcan FG, and Şahin AS
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- Humans, Prospective Studies, Female, Male, Adult, Middle Aged, Aged, Adolescent, Infant, Young Adult, Infant, Newborn, Child, Child, Preschool, Risk Assessment methods, Risk Assessment statistics & numerical data, Aged, 80 and over, Clinical Decision-Making methods, Health Status, Preoperative Care methods, Preoperative Care statistics & numerical data, Preoperative Care standards, Risk Factors, Anesthesiologists statistics & numerical data, Anesthesiology standards, Reproducibility of Results, Anesthesia methods
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Background: This study investigates the potential of ChatGPT-4, developed by OpenAI, in enhancing medical decision-making processes, particularly in preoperative assessments using the American Society of Anesthesiologists (ASA) scoring system. The ASA score, a critical tool in evaluating patients' health status and anesthesia risks before surgery, categorizes patients from I to VI based on their overall health and risk factors. Despite its widespread use, determining accurate ASA scores remains a subjective process that may benefit from AI-supported assessments. This research aims to evaluate ChatGPT-4's capability to predict ASA scores accurately compared to expert anesthesiologists' assessments., Methods: In this prospective multicentric study, ethical board approval was obtained, and the study was registered with clinicaltrials.gov (NCT06321445). We included 2851 patients from anesthesiology outpatient clinics, spanning neonates to all age groups and genders, with ASA scores between I-IV. Exclusion criteria were set for ASA V and VI scores, emergency operations, and insufficient information for ASA score determination. Data on patients' demographics, health conditions, and ASA scores by anesthesiologists were collected and anonymized. ChatGPT-4 was then tasked with assigning ASA scores based on the standardized patient data., Results: Our results indicate a high level of concordance between ChatGPT-4 predictions and anesthesiologists' evaluations, with Cohen's kappa analysis showing a kappa value of 0.858 (p = 0.000). While the model demonstrated over 90% accuracy in predicting ASA scores I to III, it showed a notable variance in ASA IV scores, suggesting a potential limitation in assessing patients with more complex health conditions., Discussion: The findings suggest that ChatGPT-4 can significantly contribute to the medical field by supporting anesthesiologists in preoperative assessments. This study not only demonstrates ChatGPT-4's efficacy in medical data analysis and decision-making but also opens new avenues for AI applications in healthcare, particularly in enhancing patient safety and optimizing surgical outcomes. Further research is needed to refine AI models for complex case assessments and integrate them seamlessly into clinical workflows., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)
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- 2024
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6. Quality measures in pre-liver transplant care by the Practice Metrics Committee of the American Association for the Study of Liver Diseases.
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Brahmania M, Kuo A, Tapper EB, Volk ML, Vittorio JM, Ghabril M, Morgan TR, Kanwal F, Parikh ND, Martin P, Mehta S, Winder GS, Im GY, Goldberg D, Lai JC, Duarte-Rojo A, Paredes AH, Patel AA, Sahota A, McElroy LM, Thomas C, Wall AE, Malinis M, Aslam S, Simonetto DA, Ufere NN, Ramakrishnan S, Flynn MM, Ibrahim Y, Asrani SK, and Serper M
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- Humans, United States, Preoperative Care standards, Preoperative Care methods, Delphi Technique, Quality Indicators, Health Care, Liver Transplantation standards, Waiting Lists
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The liver transplantation (LT) evaluation and waitlisting process is subject to variations in care that can impede quality. The American Association for the Study of Liver Diseases (AASLD) Practice Metrics Committee (PMC) developed quality measures and patient-reported experience measures along the continuum of pre-LT care to reduce care variation and guide patient-centered care. Following a systematic literature review, candidate pre-LT measures were grouped into 4 phases of care: referral, evaluation and waitlisting, waitlist management, and organ acceptance. A modified Delphi panel with content expertise in hepatology, transplant surgery, psychiatry, transplant infectious disease, palliative care, and social work selected the final set. Candidate patient-reported experience measures spanned domains of cognitive health, emotional health, social well-being, and understanding the LT process. Of the 71 candidate measures, 41 were selected: 9 for referral; 20 for evaluation and waitlisting; 7 for waitlist management; and 5 for organ acceptance. A total of 14 were related to structure, 17 were process measures, and 10 were outcome measures that focused on elements not typically measured in routine care. Among the patient-reported experience measures, candidates of LT rated items from understanding the LT process domain as the most important. The proposed pre-LT measures provide a framework for quality improvement and care standardization among candidates of LT. Select measures apply to various stakeholders such as referring practitioners in the community and LT centers. Clinically meaningful measures that are distinct from those used for regulatory transplant reporting may facilitate local quality improvement initiatives to improve access and quality of care., (Copyright © 2024 American Association for the Study of Liver Diseases.)
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- 2024
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7. Understanding Obstetrical Surgical Planning for the Pediatrician.
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Schuyler AQ, Koch FR, and Goodier CG
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- Humans, Pregnancy, Female, Pediatricians, Clinical Decision-Making, Infant, Newborn, Preoperative Care standards, Preoperative Care methods, Cesarean Section
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Cesarean deliveries are common in the United States, occurring in approximately one-third of deliveries in 2021. Given this high rate of cesarean deliveries, it is important for all clinicians caring for the pregnant person-infant dyad to be educated about cesarean deliveries. In this review, we describe the indications for cesarean delivery, the evidence-based practices of preoperative planning to ensure safe deliveries, and the clinical decision-making behind various cesarean incisions. In addition, we discuss the most common complications of cesarean deliveries for the pregnant person-infant dyad., (Copyright © 2024 by the American Academy of Pediatrics.)
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- 2024
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8. Improving Compliance With Evidence-Based Laboratory Testing Recommendations and Monitoring Associated Patient Outcomes.
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Hawkins A, Moynihan AM, Glassman K, and Clarke S
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- Humans, Preoperative Care methods, Preoperative Care standards, New England, Clinical Laboratory Techniques standards, Clinical Laboratory Techniques methods, Guideline Adherence statistics & numerical data, Guideline Adherence standards
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A team comprising nursing, medical staff, and administrative leaders at an urban academic orthopedic hospital in the northeastern United States sought to revise a preoperative laboratory testing protocol based on evidence and practice guidelines. The goal was to decrease unnecessary tests by 20% without negatively affecting patient outcomes. After adding the revised protocol to the electronic health record, audits revealed that the target goal was not met and additional strategies were implemented, including educational webinars for surgeon office personnel who ordered tests, additional webinars for advanced practice professionals, and the creation of scorecards to track surgeons' progress. Overall, a downward trend in the ordering of unnecessary laboratory tests for patients without identified risks was observed, but a 20% reduction was not achieved. Surgical complications during the project were not associated with laboratory tests. Clinicians continue to use the revised preoperative laboratory testing protocol at the facility., (© AORN, Inc, 2024.)
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- 2024
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9. The pre-transplant evaluation: Considerations for trainees and early career transplant infectious diseases clinician.
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Kumar RN, Gorsline CA, Rader T, Boucher HW, Malinis M, Koff A, and Harris CE
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- Humans, Risk Factors, Preoperative Care methods, Preoperative Care standards, Organ Transplantation adverse effects, Communicable Diseases
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Transplant infectious disease (TID) clinicians are integral to the pre-transplantation evaluation. Pre-transplant evaluations allow clinicians to assess risk factors for latent infections and relevant exposures to potential pathogens, address immunizations, and optimize patients' health and understanding of life after transplant. However, there is not a standardized approach to the pre-transplant evaluation. This article reviews the details of performing successful pre-transplant evaluations, including updated recommendations on available vaccines and contemporary opinions on marijuana use. This resource can be used for teaching with trainees or for early career TID clinicians., (© 2024 Wiley Periodicals LLC.)
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- 2024
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10. A Qualitative Analysis of the Impact of Preoperative Mindfulness-Based Stress Reduction on Total Knee Arthroplasty Surgical Experiences.
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Reynolds KA, Sommer JL, Roy R, Kornelsen J, Mackenzie CS, and El-Gabalawy R
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- Humans, Female, Male, Aged, Middle Aged, Adaptation, Psychological, Preoperative Care methods, Preoperative Care psychology, Preoperative Care standards, Aged, 80 and over, Arthroplasty, Replacement, Knee psychology, Arthroplasty, Replacement, Knee methods, Mindfulness methods, Mindfulness standards, Qualitative Research, Stress, Psychological psychology, Stress, Psychological prevention & control
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We qualitatively explored the impact of preoperative mindfulness-based stress reduction (MBSR) on total knee arthroplasty (TKA) experiences. Participants (n = 10) who received MBSR prior to TKA participated in semi-structured interviews concerning their experiences with MBSR and its perceived impact on surgery. We analyzed interviews according to reflexive thematic analysis, and coded data into three main themes: 1) Impact of MBSR on surgery experiences; 2) Contributors to change; and 3) Motivations for participation. Participants noted they were able to relax, feel more confident, and cope more effectively during the preoperative period, and that others in their lives noticed positive changes following their participation in MBSR. Participants' openness to mindfulness and health-related beliefs and may have contributed to the positive impacts they experienced from MBSR. Participants described being motivated to participate in MBSR to help them prepare for their surgery and to learn new coping strategies. Participants described a strong level of commitment to the intervention. With further research, integration of MBSR into prehabilitation for TKA may be appropriate., Competing Interests: Declaration of competing interest The authors declare that they have no known competinsg financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)
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- 2024
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11. Validity of an Administrative Claims-Based Measure of Low-Value Preoperative Cardiac Stress Testing.
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Klahr R, Smith M, Wu K, Han J, Casale PN, and Kini V
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- Humans, Reproducibility of Results, United States, Female, Preoperative Care standards, Male, Middle Aged, Aged, Databases, Factual, Risk Assessment, Risk Factors, Predictive Value of Tests, Administrative Claims, Healthcare, Exercise Test
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Competing Interests: None.
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- 2024
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12. Evaluating the effect of preoperative interventions on sleep health in the perioperative period: a systematic review.
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Sibley D, Sellers D, Randall I, Englesakis M, Culos-Reed SN, Singh M, and Mina DS
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- Humans, Perioperative Period, Sleep physiology, Sleep Wake Disorders etiology, Preoperative Care methods, Preoperative Care standards
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Surgery and general anaesthesia have deleterious effects on sleep and disrupted perioperative sleep health is a risk factor for poor surgical outcomes. The objective of this systematic review was to summarise preoperative interventions that report sleep outcomes. Studies that delivered an intervention initiated >24 h prior to surgery among an adult sample without a diagnosed sleep disorder were included. Studies were excluded if they were preclinical or were not published in English. MEDLINE, MEDLINE ePubs Ahead of Print and In-process Citations, Embase, Cochrane Central Register of Controlled Trials, APA PsycINFO, CINAHL, and the Web of Science were searched on February 2, 2023. This review was reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses and was registered with the International Prospective Register of Systematic Reviews (identifier: CRD42021260578). Risk of bias was assessed using the Cochrane Risk-of Bias 2 tool for randomised trials and the Risk Of Bias In Non-randomised Studies - of Interventions for non-randomised trials. Certainty of findings were assessed using the Grading of Recommendations, Assessment, Development and Evaluation framework. The searching yielded 10,938 total citations, and after screening resulted in 28 randomised and 19 non-randomised trials (47 total) with 4937 participants. Sleep was a primary outcome in 16 trials; a sleep outcome was significantly improved relative to comparator in 23 trials. This review demonstrates that preoperative sleep is modifiable via a variety of interventions, including pharmacological, non-pharmacological, and nursing interventions delivered preoperatively or perioperatively. Our results should be considered with caution due to an overall intermediate to high risk of bias in the included trials, and low to very low certainty of evidence. This review supports the modifiability of sleep health among surgical patients and provides the groundwork for preoperative sleep optimisation research., (© 2023 The Authors. Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Sleep Research Society.)
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- 2024
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13. Coronary artery calcium assessment on non-gated chest CT to optimize pre-operative cardiac screening in liver transplantation.
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Groen RA, Barbero FL, Fischer SE, van Dijkman PRM, Bax JJ, Tushuizen ME, Jukema JW, Coenraad MJ, and de Graaf MA
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- Humans, Male, Female, Middle Aged, Aged, Adult, Tomography, X-Ray Computed methods, Computed Tomography Angiography methods, Coronary Angiography methods, Coronary Vessels diagnostic imaging, Retrospective Studies, Liver Transplantation, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease surgery, Vascular Calcification diagnostic imaging, Preoperative Care methods, Preoperative Care standards
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Background: Guidelines recommend standard pre-operative cardiac screening in all liver transplantation (LT) recipients, despite the relatively low prevalence of obstructive coronary artery disease. Most LT recipients often have non-gated computed tomography (CT) performed of the chest and abdomen. This study evaluated the ability of coronary artery calcification (CAC) assessment on consecutively available scans, to identify a selection of low-risk patients, in whom further cardiac imaging can be safely withheld., Methods: LT recipients with prior non-gated CT chest-abdomen were included. CAC was visually scored on a semi-quantitative ordinal scale. Stress myocardial perfusion, coronary CT angiography (CCTA) and invasive coronary angiography (ICA) were used as golden standard. The sensitivity and specificity of CAC to exclude and predict obstructive CAD were assessed. In addition, peri- and postoperative mortality and cardiac events were analyzed., Results: 149 LT recipients (ranged 31-71 years) were included. In 75% of patients, no CAC and mild CAC could rule out obstructive CAD on CCTA and ICA with 100% certainty. The threshold of mild CAC had a sensitivity of 100% for both CCTA and ICA and a specificity of 91% and 68%, respectively. None of the patients with no or mild calcifications experienced peri- and post-operative cardiac events or died of cardiac causes., Conclusion: Visual evaluation of CAC on prior non-gated CT can accurately and safely exclude obstructive CAD in LT recipients. Incorporation of these already available data can optimize cardiac screening, by safely withholding or correctly allocating dedicated cardiac imaging in LT recipients. Thereby, reducing patients' test burden and save health care expenses., Competing Interests: Declaration of competing interest There is no conflict of interest for the present manuscript., (Copyright © 2024. Published by Elsevier B.V.)
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- 2024
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14. The Cross-Sectional Area Ratio of Right-to-Left Portal Vein Predicts the Effect of Preoperative Right Portal Vein Embolization.
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Jo Y, Lee HW, Han HS, Yoon YS, and Cho JY
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- Humans, Male, Female, Middle Aged, Retrospective Studies, Aged, Tomography, X-Ray Computed methods, Preoperative Care methods, Preoperative Care standards, Preoperative Care statistics & numerical data, Adult, Liver diagnostic imaging, Liver blood supply, Portal Vein diagnostic imaging, Embolization, Therapeutic methods, Embolization, Therapeutic statistics & numerical data, Hepatectomy methods, Liver Neoplasms surgery, Liver Neoplasms therapy, Liver Neoplasms diagnostic imaging
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Background and Objectives: Preoperative right portal vein embolization (RPVE) is often attempted before right hepatectomy for liver tumors to increase the future remnant liver volume (FRLV). Although many factors affecting FRLV have been discussed, few studies have focused on the ratio of the cross-sectional area of the right portal vein to that of the left portal vein (RPVA/LPVA). The aim of the present study was to evaluate the effect of RPVA/LPVA on predicting FRLV increase after RPVE. Materials and Methods: The data of 65 patients who had undergone RPVE to increase FRLV between 2004 and 2021 were investigated retrospectively. Using computed tomography scans, we measured the total liver volume (TLV), FRLV, the proportion of FRLV relative to TLV (FRLV%), the increase in FRLV% (ΔFRLV%), and RPVA/LPVA twice, immediately before and 2-3 weeks after RPVE; we analyzed the correlations among those variables, and determined prognostic factors for sufficient ΔFRLV%. Results: Fifty-four patients underwent hepatectomy. Based on the cut-off value of RPVA/LPVA, the patients were divided into low (RPVA/LPVA ≤ 1.20, N = 30) and high groups (RPVA/LPVA > 1.20, N = 35). The ΔFRLV% was significantly greater in the high group than in the low group (9.52% and 15.34%, respectively, p < 0.001). In a multivariable analysis, RPVA/LPVA (HR = 20.368, p < 0.001) was the most significant prognostic factor for sufficient ΔFRLV%. Conclusions: RPVE was more effective in patients with higher RPVA/LPVA, which is an easily accessible predictive factor for sufficient ΔFRLV%.
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- 2024
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15. Identification and management of preoperative anaemia in adults: A British Society for Haematology Guideline update.
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Hands K, Daru J, Evans C, Kotze A, Lewis C, Narayan S, Richards T, Taylor C, Timmins S, and Wilson A
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- Humans, Adult, Blood Transfusion, Anemia, Iron-Deficiency diagnosis, Anemia, Iron-Deficiency therapy, Anemia, Iron-Deficiency etiology, United Kingdom, Anemia therapy, Anemia diagnosis, Anemia etiology, Preoperative Care standards, Hematinics therapeutic use
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This updated British Society for Haematology guideline provides an up-to-date literature review and recommendations regarding the identification and management of preoperative anaemia. This includes guidance on thresholds for the diagnosis of anaemia and the diagnosis and management of iron deficiency in the preoperative context. Guidance on the appropriate use of erythropoiesis-stimulating agents and preoperative transfusion is also provided., (© 2024 British Society for Haematology and John Wiley & Sons Ltd.)
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- 2024
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16. Clinical recommendations for conducting pediatric functional language and memory mapping during the phase I epilepsy presurgical workup.
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Ailion A, Duong P, Maiman M, Tsuboyama M, and Smith ML
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- Humans, Child, Magnetic Resonance Imaging, Neurosurgical Procedures standards, Memory physiology, Preoperative Care standards, Epilepsy surgery, Epilepsy physiopathology, Epilepsy diagnostic imaging, Brain Mapping
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Objective: Pediatric epilepsy surgery effectively controls seizures but may risk cognitive, language, or memory decline. Historically, the intra-carotid anesthetic procedure (IAP or Wada Test) was pivotal for language and memory function. However, advancements in noninvasive mapping, notably functional magnetic resonance imaging (fMRI), have transformed clinical practice, reducing IAP's role in presurgical evaluations. Method: We conducted a critical narrative review on mapping technologies, including factors to consider for discordance. Results: Neuropsychological findings suggest that if pre-surgery function remains intact and the surgery targets the eloquent cortex, there is a high chance for decline. Memory and language decline are particularly pronounced post-left anterior temporal lobe resection (ATL), making presurgical cognitive assessment crucial for predicting postoperative outcomes. However, the risk of functional decline is not always clear - particularly with higher rates of atypical organization in pediatric epilepsy patients and discordant findings from cognitive mapping. We found little research to date on the use of IAP and other newer technologies for lateralization/localization in pediatric epilepsy. Based on this review, we introduce an IAP decision tree to systematically navigate discordance in IAP decisions for epilepsy presurgical workup. Conclusions: Future research should be aimed at pediatric populations to improve the precision of functional mapping, determine which methods predict post-surgical deficits and then create evidence-based practice guidelines to standardize mapping procedures. Explicit directives are needed for resolving conflicts between developing mapping procedures and established clinical measures. The proposed decision tree is the first step to standardize when to consider IAP or invasive mapping, in coordination with the multidisciplinary epilepsy surgical team.
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- 2024
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17. A Comparative Analysis and Results of Carotid Interventions Based on Duplex Ultrasound as a Single Exam Versus Multiple Diagnose Exams.
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de Athayde Soares R, Câmara Costa Ferreira ZM, Viana Portela MV, Campelo Campos AB, Matielo MF, Pecego CS, and Sacilotto R
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- Computed Tomography Angiography standards, Magnetic Resonance Angiography standards, Carotid Stenosis diagnostic imaging, Carotid Stenosis surgery, Preoperative Care standards, Humans, Male, Female, Middle Aged, Aged, Aged, 80 and over, Kaplan-Meier Estimate, Stroke epidemiology, Risk Factors, Incidence, Ultrasonography, Doppler, Duplex standards, Carotid Artery, Internal diagnostic imaging, Carotid Artery, Internal surgery
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Background: To determine the results, safety, and clinical outcomes of carotid interventions performed with duplex ultrasound (DUS) as a single preoperative image for internal carotid artery (ICA) assessment, compared to computed tomography angiography (CTA) and magnetic resonance angiography (MRA)., Methods: Prospective, consecutive cohort study of 2 groups of patients submitted to carotid interventions, 1 group of patients with DUS as a sole exam (group DUS) compared to patients with DUS plus CTA or MRA for ICA stenosis diagnosis (group CTA/MRA) regarding clinical outcomes such as major stroke, minor stroke, transient ischemic attack and perioperative mortality., Results: Two groups of patients were identified: group DUS with 47 patients and group CTA/MRA plus DUS with 68 patients. The mean age of the patients was 71.67 years in total cohort, and most of them were male (66.1%). Group DUS had higher prevalence of male, dyslipidemia, ischemic heart disease, peripheral artery disease and chronic kidney disease than group CTA/MRA (83% vs. 54.4%, P = 0.001; 93.6% vs. 51.5%, P < 0.001; 36.2% vs. 16.2%, P = 0.009; 29.8% vs. 13.2%, P = 0.019; 14.9% vs. 5.9%, P = 0.007, respectively). We have performed a Kaplan-Meier regarding survival rates: Group DUS had 93.5%% and Group CTA/MRA had 90.3%% at 720 days. P = 0.15, standard error < 10 at 720 days. a Kaplan-Meier analysis regarding primary patency rates showed Group DUS with 92.7% and Group CTA/MRA with 94.7% at 720 days. P = 0.78, standard error < 10 at 720 days. Furthermore, the incidence of postoperative stroke was 2.6% (asymptomatic 1.7%, symptomatic 2.9%), with no differences among DUS and CTA/MRA groups (2.1% vs. 2.9%, P = 0.78, respectively)., Conclusions: Independently of the type of carotid intervention (carotid endarterectomy and carotid stenting (CAS)), DUS as an only preoperative carotid image has similar results regarding postoperative outcomes when compared to CTA/MRA for preoperative carotid evaluation., (Copyright © 2023 Elsevier Inc. All rights reserved.)
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- 2024
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18. Implementing an innovative, patient-centered approach to day case arthroplasty: improving patient outcomes through remote preoperative pharmacist consultations.
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Fitzpatrick K, Addie K, Shaw M, Higginson R, Hudman L, Samuel J, Forrest R, and MacTavish P
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- Humans, Male, Female, Aged, Middle Aged, Ambulatory Surgical Procedures methods, Remote Consultation, Pharmacy Service, Hospital methods, Pharmacy Service, Hospital standards, Referral and Consultation, Length of Stay, Aged, 80 and over, Pharmacists standards, Arthroplasty, Replacement, Hip, Arthroplasty, Replacement, Knee, COVID-19, Patient-Centered Care, Preoperative Care methods, Preoperative Care standards
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Objective: Elective surgery suffered significant loss of capacity during the COVID-19 pandemic. To address this, hip and knee arthroplasties are being conducted as day case procedures. Pre-admission pharmacist consultations were introduced (the intervention) for these patients. This consultation aimed to address perioperative medicines issues, promote patient empowerment, improve prescribing quality and contribute to reduction in length of stay (LoS)., Methods: All patients listed for a total/unicompartmental knee replacement (TKR/UKR) or total hip replacement (THR) at an ambulatory care hospital were identified by a pharmacist prescriber 1-2 weeks before the operation. Pharmacist consultations were conducted remotely with discharge prescriptions written electronically and dispensed before admission. Prescribing data were collected for both pre-intervention (n=80) and post-intervention (n=129) groups along with all interventions undertaken during consultations. Staff opinion was sought via online questionnaire and patient opinion was gathered via post-discharge telephone calls., Results: A total of 115 interventions took place during 129 patient consultations and >75% of interventions were of a significance expected to improve patient care. Prescribing standards were improved in the intervention group compared with patients whose arthroplasty was before the introduction of this service. The pharmacy service would have produced a different prescription in 38.8% of the pre-intervention group. Staff and patient feedback was extremely positive and all patients with previous surgical experience in the health board reported an improved experience. There was a statistically significant reduction in post-discharge healthcare encounters (such as general practitioner (GP) visits) in the intervention group., Conclusion: This novel remote preoperative pharmacist consultation improved prescribing standards, enhanced the patient's surgical experience and reduced the burden on post-discharge healthcare systems., Competing Interests: Competing interests: None declared., (© European Association of Hospital Pharmacists 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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19. Implementing a Preoperative Anemia Optimization Protocol for Cardiovascular Surgery Patients: A Quality Improvement Project.
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Rittenhouse A, Ostendorf M, Johns C, and Gerdisch M
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- Humans, Female, Male, Aged, Middle Aged, Retrospective Studies, Clinical Protocols standards, Aged, 80 and over, Postoperative Complications prevention & control, Cardiac Surgical Procedures adverse effects, Cardiac Surgical Procedures standards, Adult, Cardiovascular Surgical Procedures adverse effects, Cardiovascular Surgical Procedures standards, Critical Care Nursing standards, Anemia, Quality Improvement, Preoperative Care standards, Preoperative Care methods
- Abstract
Background: Patients with anemia have poorer outcomes following cardiac surgery than do those without anemia. To improve outcomes, the Enhanced Recovery After Surgery cardiac recommendations include optimizing patients' condition, including treating anemia, before surgery., Local Problem: Despite implementing Enhanced Recovery After Surgery initiatives, a midwestern cardiothoracic surgery group recognized a care gap in preoperative patients with anemia. No standardized protocol was in use., Methods: An anemia optimization protocol was developed for perioperative care of patients with anemia. Data from retrospective medical record review were analyzed to determine relationships between protocol use and secondary outcomes. The protocol was created using best evidence and expert consensus. Cardiac surgery and hematology specialists revised the protocol and agreed on a final version. The protocol was integrated into the consultation process for cardiac surgery patients., Results: During the implementation period, 23 of 55 patients with anemia (42%) received interventions via the anemia optimization protocol. The mean quantity of packed red blood cells transfused perioperatively per patient was 1.9 U in the protocol group and 3.5 U in the nonprotocol group. In the subgroup of patients experiencing postoperative acute kidney injury, the mean increase in creatinine level was 0.65 mg/dL in the protocol group and 1.52 mg/dL in the nonprotocol group. Four patients in the protocol group (17%) and 6 patients in the nonprotocol group (19%) experienced postoperative acute kidney injury., Conclusion: Preoperative anemia is associated with poorer cardiac surgical outcomes. Incorporating the anemia optimization protocol into practice may mitigate the risk of postoperative complications for patients with anemia. Continued use of the protocol is recommended., (©2024 American Association of Critical-Care Nurses.)
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- 2024
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20. Neuropsychological assessment in pediatric epilepsy surgery: A French procedure consensus.
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Laguitton V, Boutin M, Brissart H, Breuillard D, Bilger M, Forthoffer N, Guinet V, Hennion S, Kleitz C, Mirabel H, Mosca C, Pradier S, Samson S, Voltzenlogel V, Planton M, Denos M, and Bulteau C
- Subjects
- Humans, Child, France epidemiology, Adolescent, Neurosurgical Procedures, Pediatrics standards, Pediatrics statistics & numerical data, Preoperative Care methods, Preoperative Care standards, Preoperative Care statistics & numerical data, Epilepsy surgery, Epilepsy psychology, Neuropsychological Tests standards, Consensus
- Abstract
Neuropsychological assessment is a mandatory part of the pre- and post-operative evaluation in pediatric epilepsy surgery. The neuropsychology task force of the ILAE - French Chapter aims to define a neuropsychological procedure consensus based on literature review and adapted for French practice. They performed a systematic review of the literature published between 1950 and 2023 on cognitive evaluation of individuals undergoing presurgical work-up and post-surgery follow-up and focused on the pediatric population aged 6-16. They classified publications listed in the PubMed database according to their level of scientific evidence. The systematic literature review revealed no study with high statistical power and only four studies using neuropsychological scales in their French version. Afterwards, the experts defined a neuropsychological consensus strategy in pediatric epilepsy surgery according to the psychometric determinants of cognitive tests, specificity of epilepsy, surgery context, French culture and literature reports. A common French neuropsychological procedure dedicated to pediatric epilepsy surgery is now available. This procedure could serve as a guide for the pre- and post-surgical work-up in French centers with pediatric epilepsy surgery programs. The main goal is to anticipate the functional risks of surgery, to support the postoperative outcome beyond the seizure-related one, while taking into consideration the plasticity and vulnerability of the immature brain and allowing the possibility of collaborative studies., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)
- Published
- 2024
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21. Visual supplementation is an effective tool in cataract surgery counselling by eye-care practitioners.
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Chan WT, Wu D, Lim XH, Du R, Jeyabal P, Ng L, Nabhan TI, Lim DK, Stapleton F, and Lim HL
- Subjects
- Humans, Female, Male, Aged, Middle Aged, Informed Consent psychology, Preoperative Care methods, Preoperative Care standards, Aged, 80 and over, Surveys and Questionnaires, Audiovisual Aids, Patient Satisfaction, Referral and Consultation, Cataract Extraction methods, Cataract Extraction psychology, Counseling methods, Patient Education as Topic methods
- Abstract
Background: Informed consent constitutes an important aspect of eye care. However, patients often experience difficulties understanding and retaining information presented to them during consultations. This study investigates the efficacy of pictorial aids in supplementing preoperative counselling of patients undergoing cataract surgery., Methods: Patients attending routine pre-cataract surgery counselling were randomized to receive either a standard verbal consultation (control) or a verbal consultation with a digitalized pictorial aid illustrating key surgical steps (intervention). Patients were assessed after the consultation on their knowledge, satisfaction, anxiety and preparedness using an anonymous questionnaire., Results: Seventy-six patients were recruited and randomized into the control and intervention groups. The intervention group attained better Knowledge Scores (control: 5 [2-6] vs. intervention: 6 [6]), and more patients "strongly agreed" that they were more prepared (control: 78.9% vs. intervention: 97.4%, P=0.028). A higher proportion of patients in the control group either "disagreed" or "neither disagree nor agreed (neutral)" that they were less worried (control: 15.8% vs. intervention: 0.0%, Fisher's Exact Test P=0.025). Although the consultation duration was shorter in the intervention group (21±4mins vs. 27±6mins, P<0.001), the use of digital pictorial aids during consultation resulted in more effective counselling with increased patient knowledge, easier decision-making process and reduced patient anxiety., Conclusion: Pictorial aids add to the repository of tools available to eye-care practitioners and are low-cost, easy to implement, and can effectively augment existing preoperative counselling processes to ensure accurate and effective preoperative counselling of patients., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)
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- 2024
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22. Preoperative investigation practices for elective surgical patients: clinical audit.
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Firde M and Yetneberk T
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- Humans, Female, Middle Aged, Male, Adult, Aged, Clinical Audit, Young Adult, Adolescent, Practice Guidelines as Topic, Surveys and Questionnaires, Elective Surgical Procedures, Preoperative Care methods, Preoperative Care standards
- Abstract
Background: The findings of pre-operative investigations help to identify risk factors that may affect the course of surgery or post-operative recovery by contributing to informed consent conversations between the surgical team and the patient, as well as guiding surgical and anesthetic planning. Certainly, preoperative tests are valuable when they offer additional information beyond what can be gathered from a patient's history and physical examination alone. Preoperative testing practices differ significantly among hospitals, and even within the same hospital, clinicians may have varying approaches to requesting tests. This study aimed to investigate preoperative testing practices and compare them with the latest guidelines from the National Institute for Health and Care Excellence (NICE)., Methods: This three-month institutionally based study was carried out at the Debre Tabor Comprehensive Specialized Hospital from May 1 to July 30, 2023, including individuals aged 16 years and older who were not pregnant and had undergone elective surgery in the gynecological, orthopedic, and general units. Data on the sociodemographic characteristics, the existence of comorbidities, the invasiveness of surgery, and the tests taken into consideration by the guideline were gathered using a self-administered questionnaire. After rigorously analyzing and revising the results of preoperative investigation approaches, we compared them to the standard of recommendations. Moreover, the data was analyzed and graphically presented using Microsoft Excel 2013., Results: During the data collection period, 247 elective patients underwent general, orthopedic, and gynecological operations. The majority of patients, 107 (43.32%), were between the ages of 16 and 40 and had an American Society of Anesthesiologists (ASA) class one (92.71%). 350 investigations were requested in total. Of these, 71 (20.28%) tests were ordered without a justified reason or in contravention of NICE recommendations., Conclusions: In our hospital's surgical clinical practice, unnecessary preoperative testing is still common, especially when it comes to organ function tests, electrocardiograms (ECGs), and complete blood counts (FBCs). When deciding whether preoperative studies are required, it is critical to consider aspects including a complete patient history, a physical examination, and the invasiveness of the surgery., (© 2024. The Author(s).)
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- 2024
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23. Pre-anaesthesia assessment in cataract surgery: Recommendations from the SEDAR Working Group.
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Quecedo Gutierrez L, Alsina E, Del Blanco Narciso B, Vazquez Lima A, Zaballos Garcia M, and Abad Gurumeta A
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- Humans, Informed Consent, COVID-19 prevention & control, Cataract Extraction standards, Preoperative Care methods, Preoperative Care standards, Anesthesia standards, Anesthesia methods
- Abstract
Introduction and Objectives: Cataract surgery is one of the most common procedures in outpatient surgery units. The use of information and communication technologies (ICT) in clinical practice and the advent of new health scenarios, such as the Covid pandemic, have driven the development of pre-anaesthesia assessment models that free up resources to improve access to cataract surgery without sacrificing patient safety. The approach to cataract surgery varies considerably among public, subsidised and private hospitals. This raises the need for guidelines to standardise patient assessment, pre-operative tests, management of background medication, patient information and informed consent., Results: In this document, the SEDAR Clinical Management Division together with the Major Outpatient Surgery Division SEDAR Working Group put forward a series of consensus recommendations on pre-anaesthesia testing based on the use of ITCs, health questionnaires, patient information and informed consent supervised and evaluated by an anaesthesiologist., Conclusions: This consensus document will effectivise pre-anaesthesia assessment in cataract surgery while maintaining the highest standards of quality, safety and legality., (Copyright © 2024 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)
- Published
- 2024
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24. What is the association of preoperative biopsy with recurrence and survival in retroperitoneal sarcoma? A systematic review by the Australia and New Zealand Sarcoma Association clinical practice guidelines working party.
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Webster S, Vargas AC, Maclean F, Vu J, Tong E, Coker D, Ward I, Connolly EA, Zhou DD, Mar J, Lazarakis S, Gyorki DE, and Hong AM
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- Humans, Australia epidemiology, Biopsy, New Zealand epidemiology, Practice Guidelines as Topic, Preoperative Care standards, Neoplasm Recurrence, Local pathology, Neoplasm Recurrence, Local epidemiology, Retroperitoneal Neoplasms pathology, Retroperitoneal Neoplasms mortality, Retroperitoneal Neoplasms surgery, Retroperitoneal Neoplasms diagnosis, Sarcoma mortality, Sarcoma pathology, Sarcoma diagnosis, Sarcoma therapy
- Abstract
Preoperative biopsy for retroperitoneal sarcoma (RPS) enables appropriate multidisciplinary treatment planning. A systematic review of literature from 1990 to June 2022 was conducted using the population, intervention, comparison and outcome model to evaluate the local recurrence and overall survival of preoperative biopsy compared to those that had not. Of 3192 studies screened, five retrospective cohort studies were identified. Three reported on biopsy needle tract seeding, with only one study reporting biopsy site recurrence of 2 %. Two found no significant difference in local recurrence and one found higher 5-year local recurrence rates in those who had not been biopsied. Three studies reported overall survival, including one with propensity matching, did not show a difference in overall survival. In conclusion, preoperative core needle biopsy of RPS is not associated with increased local recurrence or adverse survival outcomes., Competing Interests: Declaration of Competing Interest Stephanie Webster: Nil. Ana Cristina Vargas: Nil. Fiona Maclean: Nil. Jennifer Vu: Nil. Elissa Tong: Nil. David Coker: Nil. Iain Ward: Nil. Elizabeth Connolly: Nil. Deborah Di-Xin Zhou: Nil. Jasmine Mar: Nil. Smaro Lazarakis: Nil. David E Gyorki: Honorarium from BMS and Merck. Angela M Hong: Honorarium from Oncobeta and Telix., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)
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- 2024
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25. The deimplementation of laboratory testing in low-risk patients as recommended by the American society of anesthesiologists: An ACS-NSQIP longitudinal analysis.
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Stuart CM, Bronsert MR, Meguid RA, Mott NM, Abrams BA, Dyas AR, Gleisner AL, Colborn KL, and Henderson WG
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- Humans, Female, Male, Middle Aged, United States, Societies, Medical, Risk Assessment methods, Aged, Longitudinal Studies, Guideline Adherence statistics & numerical data, Adult, Diagnostic Tests, Routine standards, Preoperative Care standards, Preoperative Care methods, Practice Guidelines as Topic
- Abstract
Background: In 2012, the American Society of Anesthesiologists (ASA) published guidelines recommending against routine preoperative laboratory testing for low-risk patients to reduce unnecessary medical expenditures. The aim of this study was to assess the change in routine preoperative laboratory testing in low-risk versus higher-risk patients before and after release of these guidelines., Methods: The ACS-NSQIP database, 2005-2018, was separated into low-risk versus higher-risk patients based upon a previously published stratification. The guideline implementation date was defined as January 2013. Changes in preoperative laboratory testing over time were compared between low- and higher-risk patients. A difference-in-differences model was applied. The primary outcome included any laboratory test obtained ≤90 days prior to surgery., Results: Of 7,507,991 patients, 972,431 (13.0%) were defined as low-risk and 6,535,560 (87.0%) higher-risk. Use of any preoperative laboratory test declined in low-risk patients from 66.5% before to 59.6% after guidelines, a 6.9 percentage point reduction, versus 93.0%-91.9% in higher-risk patients, a 1.1 percentage point reduction (p < 0.0001, comparing percentage point reductions). After risk-adjustment, the adjusted odds ratio for having any preoperative laboratory test after versus before the guidelines was 0.77 (95% CI 0.76-0.78) in low-risk versus 0.93 (0.92-0.94) in higher-risk patients. In low-risk patients, lack of any preoperative testing was not associated with worse outcomes., Conclusions: While a majority of low-risk patients continue to receive preoperative laboratory testing not recommended by the ASA, there has been a decline after implementation of guidelines. Continued effort should be directed at the deimplementation of routine preoperative laboratory testing for low-risk patients., (© 2024 International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).)
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- 2024
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26. [Preoperative evaluation of adult patients before elective, non-cardiothoracic surgery : A joint recommendation of the German Society for Anesthesiology and Intensive Care Medicine, the German Society for Surgery and the German Society for Internal Medicine].
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Zöllner C
- Subjects
- Humans, Adult, Germany, Internal Medicine standards, Risk Assessment, Societies, Medical, General Surgery standards, Preoperative Care standards, Preoperative Care methods, Elective Surgical Procedures standards, Elective Surgical Procedures adverse effects, Anesthesiology standards, Critical Care standards
- Abstract
The 70 recommendations summarize the current status of preoperative risk evaluation of adult patients prior to elective non-cardiothoracic surgery. Based on the joint publications of the German scientific societies for anesthesiology and intensive care medicine (DGAI), surgery (DGCH), and internal medicine (DGIM), which were first published in 2010 and updated in 2017, as well as the European guideline on preoperative cardiac risk evaluation published in 2022, a comprehensive re-evaluation of the recommendation takes place, taking into account new findings, the current literature, and current guidelines of international professional societies. The revised multidisciplinary recommendation is intended to facilitate a structured and common approach to the preoperative evaluation of patients. The aim is to ensure individualized preparation for the patient prior to surgery and thus to increase patient safety. Taking into account intervention- and patient-specific factors, which are indispensable in the preoperative risk evaluation, the perioperative risk for the patient should be minimized and safety increased. The recommendations for action are summarized under "General Principles (A)," "Advanced Diagnostics (B)," and the "Preoperative Management of Continuous Medication (C)." For the first time, a rating of the individual measures with regard to their clinical relevance has been given in the present recommendation. A joint and transparent agreement is intended to ensure a high level of patient orientation while avoiding unnecessary preliminary examinations, to shorten preoperative examination procedures, and ultimately to save costs. The joint recommendation of DGAI, DGCH and DGIM reflects the current state of knowledge as well as the opinion of experts. The recommendation does not replace the individualized decision between patient and physician about the best preoperative strategy and treatment., (© 2024. The Author(s).)
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- 2024
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27. Comparative validation of automated presurgical tractography based on constrained spherical deconvolution and diffusion tensor imaging with direct electrical stimulation.
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Radwan AM, Emsell L, Vansteelandt K, Cleeren E, Peeters R, De Vleeschouwer S, Theys T, Dupont P, and Sunaert S
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- Humans, Adult, Female, Male, Middle Aged, Cross-Sectional Studies, Pyramidal Tracts diagnostic imaging, White Matter diagnostic imaging, Young Adult, Preoperative Care methods, Preoperative Care standards, Aged, Diffusion Tensor Imaging methods, Diffusion Tensor Imaging standards, Electric Stimulation methods, Brain Mapping methods, Brain Mapping standards
- Abstract
Objectives: Accurate presurgical brain mapping enables preoperative risk assessment and intraoperative guidance. This cross-sectional study investigated whether constrained spherical deconvolution (CSD) methods were more accurate than diffusion tensor imaging (DTI)-based methods for presurgical white matter mapping using intraoperative direct electrical stimulation (DES) as the ground truth., Methods: Five different tractography methods were compared (three DTI-based and two CSD-based) in 22 preoperative neurosurgical patients undergoing surgery with DES mapping. The corticospinal tract (CST, N = 20) and arcuate fasciculus (AF, N = 7) bundles were reconstructed, then minimum distances between tractograms and DES coordinates were compared between tractography methods. Receiver-operating characteristic (ROC) curves were used for both bundles. For the CST, binary agreement, linear modeling, and posthoc testing were used to compare tractography methods while correcting for relative lesion and bundle volumes., Results: Distance measures between 154 positive (functional response, pDES) and negative (no response, nDES) coordinates, and 134 tractograms resulted in 860 data points. Higher agreement was found between pDES coordinates and CSD-based compared to DTI-based tractograms. ROC curves showed overall higher sensitivity at shorter distance cutoffs for CSD (8.5 mm) compared to DTI (14.5 mm). CSD-based CST tractograms showed significantly higher agreement with pDES, which was confirmed by linear modeling and posthoc tests (P
FWE < .05)., Conclusions: CSD-based CST tractograms were more accurate than DTI-based ones when validated using DES-based assessment of motor and sensory function. This demonstrates the potential benefits of structural mapping using CSD in clinical practice., (© 2024 The Authors. Human Brain Mapping published by Wiley Periodicals LLC.)- Published
- 2024
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28. Short- and long-term predictive power of the preoperative Geriatric Assessment components in older patients undergoing cholecystectomy.
- Author
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Szabat K, Skorus U, Kupniewski K, and Kenig J
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- Humans, Aged, Female, Male, Aged, 80 and over, Postoperative Complications epidemiology, Preoperative Care methods, Preoperative Care standards, Preoperative Care statistics & numerical data, Cholecystectomy methods, Cholecystectomy, Laparoscopic, Follow-Up Studies, Frailty diagnosis, Prospective Studies, Geriatric Assessment methods
- Abstract
<b><br>Introduction:</b> Increasing numbers of older patients will require laparoscopic cholecystectomies. Physicians may have doubts when qualifying these patients for elective surgeries since older age is considered a risk factor for complications. Determining biological age, using a Geriatric Assessment (GA), should be the key factor in the preoperative assessment.</br> <b><br>Aim:</b> The aim of this study was to determine which GA components and frailty alone are most useful for predicting postoperative outcomes in both short- and long-term follow-up.</br> <b><br>Materials and methods:</b> 219 consecutive patients aged ≥70 years underwent surgery and were followed up prospectively for 12 months. The preoperative GA consisted of functionality, physical activity, comorbidity, polypharmacotherapy, nutrition, cognition, mood, and social support domains. Logistic regression analyses were used to analyze the predictive ability of GA.</br> <b><br>Results:</b> GA, frailty, and chronological age were not predictive of major 30-day morbidity. There were significantly more overall postoperative complications in the frail group than in the fit group (21% vs 4%), with mainly minor (Clavien-Dindo I, II) and medical (16 patients; 72.7%) complications. There were no significant differences in the rate of major and surgical complications (8 patients; 36.4%) between frail and fit patients. Only frailty was a predictor of 1-year mortality odd ratio 12.17 (2.47-59.94) P = 0.002.</br> <b><br>Conclusions:</b> Performing GA before elective laparoscopic cholecystectomies seems unnecessary for the evaluation of short-term outcomes but helpful for the assessment of long-term outcomes. Laparoscopic cholecystectomy can be safely performed also in older frail patients.</br>.
- Published
- 2024
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29. Diagnostic test accuracy of preoperative nutritional screening tools in adults for malnutrition: a systematic review and network meta-analysis.
- Author
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Cheung HHT, Joynt GM, and Lee A
- Subjects
- Humans, Network Meta-Analysis, Adult, Postoperative Complications diagnosis, Mass Screening methods, Mass Screening standards, Sensitivity and Specificity, Nutritional Status, Malnutrition diagnosis, Nutrition Assessment, Preoperative Care standards, Preoperative Care methods
- Abstract
Background: Good nutritional screening tests can triage malnourished patients for further assessment and management by dietitians before surgery to reduce the risk of postoperative complications. The authors assessed the diagnostic test accuracy of common nutritional screening tools for preoperative malnutrition in adults undergoing surgery and determined which test had the highest accuracy., Methods: MEDLINE, EMBASE, CINAHL, and Web of Science were searched for relevant titles with no language restriction from inception till 1 January 2023. Studies reporting on the diagnostic test accuracy of preoperative malnutrition in adults using one or more of the following index nutritional screening tools were included: Malnutrition Screening Tool (MST), Malnutrition Universal Screening Tool (MUST), Mini Nutritional Assessment (MNA), short-form Mini Nutritional Assessment (MNA-SF), Nutritional Risk Index (NRI), Nutrition Risk Screening Tool 2002 (NRS-2002), and Preoperative Nutrition Screening (PONS). The reference standard was the Subjective Global Assessment (SGA) before surgery. Random-effects bivariate binomial model meta-analyses, meta-regressions, and a network meta-analysis were used to estimate the pooled and relative sensitivities and specificities., Results: Of the 16 included studies (5695 participants with an 11 957 index and 11 957 SGA tests), all were conducted after hospital admission before surgery. Eleven studies ( n =3896) were at high risk of bias using the Quality Assessment of Diagnostic Accuracy Studies tool due to a lack of blinded assessments. MUST had the highest overall test accuracy performance (sensitivity 86%, 95% CI: 75-93%; specificity 89%, 95% CI: 83-93%). Network meta-analysis showed NRI had similar relative sensitivity (0.93, 95% CI: 0.77-1.13) but lower relative specificity (0.75, 95% CI: 0.61-0.92) than MUST., Conclusions: Of all easy-to-use tests applicable at the bedside, MUST had the highest test accuracy performance for screening preoperative malnutrition. However, its predictive accuracy is likely insufficient to justify the application of nutritional optimization interventions without additional assessments., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)
- Published
- 2024
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30. Prehabilitation in gynecological oncology - are we ready to implement the program in polish oncological centers?
- Author
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Zebalski M, Szanecki W, Szostek P, and Nowosielski K
- Subjects
- Humans, Female, Poland, Gynecologic Surgical Procedures, Preoperative Care methods, Preoperative Care standards, Genital Neoplasms, Female surgery, Preoperative Exercise
- Abstract
Objectives: Prehabilitation is a concept of holistic approach to the patient and includes preoperative efforts focused on optimalization of patient's general condition. The idea of prehabilitation started at the beginning of the 21st century. However, prehabilitation programs in gynecological cancer patients are not standardized and are heterogeneous. The aim of the study it to present the concept of prehabilitation and propose prehabilitation protocol to be introduced in Polish oncological centers., Material and Methods: A search in PubMed, Medline, EMBASE (Ovid) and PsycINFO databases was conducted using the following keywords: prehabilitation, gynecological, abdominal surgery, and cancer. The primary outcomes were complications, hospitalization stay, intensive care unit transfer rate, blood loss, wound healing, and reoperation rate. The search was performed in July 2022 and covered the period from 1st January 2000 till 30th June 2022., Results: A total number of 1,118 articles have been identified. Out of all eligible papers only 42 fulfilled the research criteria and were included in the study. The analysis showed that there is no standardized prehabilitation protocol for gynecological cancer surgery, although most include three-modal approach - physical activity, nutrition, and psychological intervention. There is no standard model for physical capacity evaluation, however, 1,118 6 Minute Walk Test (6MWT) is the most common. Frailty evaluation is based on different measurements that prevent from direct comparison of obtained results between studies., Conclusions: We are not ready to implement the prehabilitation program in polish oncological centers. The main reason elvicz is: lack of accredited ovarian cancer centers, lack of well-established standardized prehabilitation programs for gynecological malignancies (ovarian cancer especially), and lack of proper information for patients about advantages of adequate preparation elvic expected surgery. Furter studies on different prehabilitation programs and information campaigns both for patients and gynecologist are required to make implementing prehabilitation possible in Poland.
- Published
- 2024
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31. [Polypharmacy and medication review in the context of prehabilitation].
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Wiedemann A, Stein J, Manseck A, Kirschner-Hermanns R, Bannowsky A, Wirz S, Kuru TH, and Salem J
- Subjects
- Aged, Humans, Hospitalization, Drug Interactions, Medication Review, Multimorbidity, Polypharmacy prevention & control, Preoperative Care rehabilitation, Preoperative Care standards
- Abstract
Against the background of typical geriatric multimorbidity and with the particular vulnerability of geriatric patients, polypharmacy deserves special attention. In accordance with the guidelines, medication should not only be reviewed regularly, but also on an ad hoc basis and with each hospital stay-and also in the context of prehabilitation. Thus, not only substances that interfere with the currently planned intervention, anesthesia, or risk of bleeding should be considered, but any medication that increases common risks for geriatric patients. These include drugs that cause or increase a tendency to fall, induce delirium, or alter the comedication through potential drug-drug interactions. Measures to minimize the risk include the following: exact documentation of medications, structured and complete transfer of information, patient and family training about any side effects that may occur, a recall system for possible laboratory checks, and compliance with the instructions for taking the medication., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)
- Published
- 2023
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32. COVID-19 Preprocedure Testing Considerations.
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Bamgbose E, Reede L, Jeter L, and Greenier E
- Subjects
- Humans, SARS-CoV-2, Nurse Anesthetists, Infection Control standards, Infection Control methods, Preoperative Care standards, Pandemics prevention & control, United States, COVID-19 prevention & control, COVID-19 Testing
- Abstract
The COVID-19 pandemic has presented significant patient and provider safety concerns, notably for clinicians involved in aerosol-generating procedures. Healthcare systems established new and innovative ways to function safely and maintain operations, including mandatory preoperative testing, changes to patient scheduling, infection control practices, staffing, surgical prioritization, environmental cleaning, and operating room processing. This article provides practice and policy considerations for preprocedure COVID-19 testing, taking into consideration the available evidence and variability in community prevalence, rate of vaccinations, and new COVID-19 variants., Competing Interests: Name: Elizabeth Bamgbose, PhD, CRNA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: Member of the FY23 Infection Control Advisory Panel. Name: Lynn Reede, DNP, MBA, CRNA, FNAP Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: Member of the FY23 Infection Control Advisory Panel. Name: Leslie Jeter, DNP, MSNA, CRNA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: Member of the FY23 Infection Control Advisory Panel. Name: Ewa Greenier, MPH, MBA, CAE Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: Supports the work of the FY23 Infection Control Advisory Panel., (Copyright © by the American Association of Nurse Anesthetists.)
- Published
- 2022
33. Perioperative management of severe brain injured patients.
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Picetti E, Bouzat P, Cattani L, and Taccone FS
- Subjects
- Brain physiopathology, Brain Injuries, Traumatic complications, Brain Injuries, Traumatic surgery, Emergencies, Humans, Postoperative Care methods, Postoperative Care standards, Preoperative Care methods, Preoperative Care standards, Brain Injuries, Traumatic therapy, Intracranial Hypertension therapy, Neurosurgery methods, Neurosurgery standards
- Abstract
Traumatic brain injury (TBI) is a leading cause of mortality and disability worldwide. Head injured patients may frequently require emergency neurosurgery. The perioperative TBI period is very important as many interventions done in this stage can have a profound effect on the long-term neurological outcome. This practical concise narrative review focused mainly on: 1) the management of severe TBI patients with neurosurgical lesions admitted to a spoke center (i.e. hospital without neurosurgery) and therefore needing a transfer to the hub center (i.e. hospital with neurosurgery); 2) the management of severe TBI patients with intracranial hypertension/brain herniation awaiting for neurosurgery; and 3) the neuromonitoring-oriented management in the immediate post-operative period. The proposals presented in this review mainly apply to severe TBI patients admitted to high-income countries.
- Published
- 2022
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34. NICE withdraws quality standard on colorectal cancer treatment after "lack of consensus".
- Author
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Wilkinson E
- Subjects
- Chemoradiotherapy, Colorectal Neoplasms pathology, Humans, Preoperative Care standards, Quality of Health Care, Radiotherapy, Adjuvant, Colorectal Neoplasms therapy, National Health Programs standards, Practice Guidelines as Topic standards
- Published
- 2022
- Full Text
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35. Preoperative Point-of-Care Ultrasound to Identify Frailty and Predict Postoperative Outcomes: A Diagnostic Accuracy Study.
- Author
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Canales C, Mazor E, Coy H, Grogan TR, Duval V, Raman S, Cannesson M, and Singh SP
- Subjects
- Aged, Female, Frailty physiopathology, Hand Strength physiology, Humans, Male, Middle Aged, Postoperative Complications physiopathology, Predictive Value of Tests, Preoperative Care methods, Prospective Studies, Ultrasonography, Interventional methods, Frailty diagnostic imaging, Frailty surgery, Point-of-Care Systems standards, Postoperative Complications diagnostic imaging, Preoperative Care standards, Ultrasonography, Interventional standards
- Abstract
Background: Frailty is increasingly being recognized as a public health issue, straining healthcare resources and increasing costs to care for these patients. Frailty is the decline in physical and cognitive reserves leading to increased vulnerability to stressors such as surgery or disease states. The goal of this pilot diagnostic accuracy study was to identify whether point-of-care ultrasound measurements of the quadriceps and rectus femoris muscles can be used to discriminate between frail and not-frail patients and predict postoperative outcomes. This study hypothesized that ultrasound could discriminate between frail and not-frail patients before surgery., Methods: Preoperative ultrasound measurements of the quadriceps and rectus femoris were obtained in patients with previous computed tomography scans. Using the computed tomography scans, psoas muscle area was measured in all patients for comparative purposes. Frailty was identified using the Fried phenotype assessment. Postoperative outcomes included unplanned intensive care unit admission, delirium, intensive care unit length of stay, hospital length of stay, unplanned skilled nursing facility admission, rehospitalization, falls within 30 days, and all-cause 30-day and 1-yr mortality., Results: A total of 32 patients and 20 healthy volunteers were included. Frailty was identified in 18 of the 32 patients. Receiver operating characteristic curve analysis showed that quadriceps depth and psoas muscle area are able to identify frailty (area under the curve-receiver operating characteristic, 0.80 [95% CI, 0.64 to 0.97] and 0.88 [95% CI, 0.76 to 1.00], respectively), whereas the cross-sectional area of the rectus femoris is less promising (area under the curve-receiver operating characteristic, 0.70 [95% CI, 0.49 to 0.91]). Quadriceps depth was also associated with unplanned postoperative skilled nursing facility discharge disposition (area under the curve 0.81 [95% CI, 0.61 to 1.00]) and delirium (area under the curve 0.89 [95% CI, 0.77 to 1.00])., Conclusions: Similar to computed tomography measurements of psoas muscle area, preoperative ultrasound measurements of quadriceps depth shows promise in discriminating between frail and not-frail patients before surgery. It was also associated with skilled nursing facility admission and postoperative delirium., (Copyright © 2021, the American Society of Anesthesiologists. All Rights Reserved.)
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- 2022
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36. Rethinking the routine: Preoperative laboratory testing among American Society of Anesthesiologists class 1 and 2 patients before low-risk ambulatory surgery in the 2017 National Surgical Quality Improvement Program cohort.
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Taylor GA, Oresanya LB, Kling SM, Saxena V, Mutter O, Raman S, Cho EY, Deitrick P, Philp MM, Sanserino K, and Kuo LE
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- Adult, Cost Savings, Diagnostic Tests, Routine economics, Female, Guideline Adherence, Humans, Male, Middle Aged, Practice Guidelines as Topic, Preoperative Care economics, Retrospective Studies, Risk Factors, Treatment Outcome, Ambulatory Surgical Procedures, Diagnostic Tests, Routine standards, Elective Surgical Procedures, Preoperative Care standards, Quality Improvement
- Abstract
Background: Routine preoperative laboratory testing is not recommended for American Society of Anesthesiologists classification 1 or 2 patients before low-risk ambulatory surgery., Methods: The 2017 National Surgical Quality Improvement Program data set was retrospectively queried for American Society of Anesthesiologists class 1 and 2 patients who underwent low-risk, elective outpatient anorectal, breast, endocrine, gynecologic, hernia, otolaryngology, oral-maxillofacial, orthopedic, plastic/reconstructive, urologic, and vascular operations. Preoperative laboratory testing was defined as any chemistry, hematology, coagulation, or liver function studies obtained ≤30 days preoperatively. Demographics, comorbidities, and outcomes were compared between those with and without testing. The numbers needed to test to prevent serious morbidity or any complication were calculated. Laboratory testing costs were estimated using Centers for Medicare and Medicaid Services data., Results: Of 111,589 patients studied, 57,590 (51.6%) received preoperative laboratory testing; 26,709 (46.4%) had at least 1 abnormal result. Factors associated with receiving preoperative laboratory testing included increasing age, female sex, non-White race/ethnicity, American Society of Anesthesiologists class 2, diabetes, dyspnea, hypertension, obesity, and steroid use. Mortality did not differ between patients with and without testing. The complication rate was 2.5% among tested patients and 1.7% among patients without tests (P < .01). The numbers needed to test was 599 for serious morbidity and 133 for any complication. An estimated $373 million annually is spent on preoperative laboratory testing in this population., Conclusion: Despite American Society of Anesthesiologists guidelines, a majority of American Society of Anesthesiologists class 1 and 2 patients undergo preoperative laboratory testing before elective low-risk outpatient surgery. The differences in the rates of complications between patients with and without testing is low. Preoperative testing should be used more judiciously in this population, which may lead to cost savings., (Copyright © 2021. Published by Elsevier Inc.)
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- 2022
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37. Diagnostic Performance of the Caprini Risk Assessment Model Combined With D-Dimer for Preoperative Deep Vein Thrombosis in Patients With Thoracolumbar Fractures Caused by High-Energy Injuries.
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Wang H, Lv B, Li W, Wang S, and Ding W
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- Adult, Biomarkers blood, Cross-Sectional Studies, Female, Humans, Lumbar Vertebrae surgery, Male, Middle Aged, Preoperative Care methods, Retrospective Studies, Risk Assessment standards, Spinal Fractures diagnosis, Spinal Fractures surgery, Thoracic Vertebrae surgery, Venous Thrombosis diagnosis, Venous Thrombosis surgery, Fibrin Fibrinogen Degradation Products metabolism, Lumbar Vertebrae injuries, Preoperative Care standards, Spinal Fractures blood, Thoracic Vertebrae injuries, Venous Thrombosis blood
- Abstract
Objective: To assess the validity of the Caprini risk assessment model (RAM) in risk stratification for deep vein thrombosis (DVT) and to investigate the diagnostic value of Caprini score combined with D-dimer in predicting DVT., Methods: This study involved 429 patients with thoracolumbar fractures caused by high-energy injuries between October 2016 and November 2019. All patients were treated surgically and had a mean age of 45.3 ± 11.4 years. Patients were risk-stratified using the 2013 Caprini RAM. Mechanical and chemical prophylaxis were used for DVT. Duplex ultrasound of both lower extremities was performed before surgery., Results: Of the 429 patients, 62 (14.45%) developed DVT. The incidence of preoperative DVT was correlated with Caprini score according to risk stratification(χ
2 = 117.4, P < 0.001). Based on the original Caprini RAM, all the patients scored in the highest risk category (score ≥5). Further substratification showed that the majority (277 of 429, 64.57%) of the patients were in the Caprini score range 7-8 and the risk of preoperative DVT was significantly higher among patients with Caprini score >10. The area under the receiver operating characteristic curve of Caprini score and D-dimer was 0.816 and 0.769 when Caprini score >8 or D-dimer >1.81mg/L was considered the criterion of predicting the risk of DVT. When combining the 2 variables, the area under the ROC curve can increase to 0.846., Conclusions: The Caprini RAM is an effective and reliable DVT risk stratification tool in patients with thoracolumbar fractures caused by high-energy injuries. Caprini score >8 or D-dimer >1.81 mg/L may predict the occurrence of preoperative DVT and the Caprini score combined with D-dimer exhibit better diagnostic performance., (Copyright © 2021 Elsevier Inc. All rights reserved.)- Published
- 2022
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38. Diagnosis of presence and extent of deep infiltrating endometriosis by preoperative MRI-improvement of staging accuracy by expert training.
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Widschwendter P, Köhler M, Friedl T, Ammann B, Janni W, Rhomberg C, Karner M, Beer M, De Gregorio A, and Polasik A
- Subjects
- Adolescent, Adult, Endometriosis physiopathology, Female, Humans, Magnetic Resonance Imaging statistics & numerical data, Middle Aged, Preoperative Care methods, Preoperative Care standards, Preoperative Care statistics & numerical data, Retrospective Studies, Sensitivity and Specificity, Endometriosis diagnostic imaging, Magnetic Resonance Imaging methods, Magnetic Resonance Imaging standards
- Abstract
Introduction: This study evaluates the clinical utility of magnetic resonance imaging (MRI) for the determination of presence and extent of DIE with special emphasis on effects of MRI reporting training MATERIAL AND METHODS: Data from 80 patients with clinically suspected DIE presented at our certified endometriosis center between 2015 and 2018 were analyzed. For all patients an ENZIAN score (describing DIE related to individual anatomical localizations) was obtained based on the preoperative MRI findings. The intraoperatively determined ENZIAN score served as the reference for assessment of diagnostic performance of the MRI., Results: Overall, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the diagnosis of DIE by MRI were 76.9%, 53.3%, 87.7% and 34.8%, respectively. Analysis by compartment revealed a sensitivity, specificity, PPV and NPV of 59.5%, 88.2%, 86.2% and 63.9%, respectively, for compartment A, with similar values for compartment B, and 50.0%, 88.9%, 64.7% and 81.4%, respectively, for the less often affected compartment C. Expert training (n = 32 before, n = 48 after) led to a considerable increase in sensitivities for the overall detection of DIE (84.6% vs. 65.4%, p = 0.071) and for the detection of DIE in compartment A (71.4% vs. 35.7%, p = 0.026), compartment B (66.7% vs. 37.5%, p = 0.057) and compartment C (75.0% vs. 20.0%, p = 0.010), without significant loss in specificity (all p > 0.50)., Discussion: After expert training, MRI has a good sensitivity with fair specificity regarding preoperative assessment of presence, location and extent of DIE., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)
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- 2022
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39. Informed Consent for Intraoperative Neural Monitoring in Thyroid and Parathyroid Surgery - Consensus Statement of the International Neural Monitoring Study Group.
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Wu CW, Huang TY, Randolph GW, Barczyński M, Schneider R, Chiang FY, Silver Karcioglu A, Wojtczak B, Frattini F, Gualniera P, Sun H, Weber F, Angelos P, Dralle H, and Dionigi G
- Subjects
- Humans, Monitoring, Intraoperative adverse effects, Parathyroid Glands surgery, Parathyroidectomy adverse effects, Preoperative Care methods, Preoperative Care standards, Thyroid Gland surgery, Thyroidectomy adverse effects, Consensus Development Conferences as Topic, Informed Consent standards, Internationality, Monitoring, Intraoperative standards, Parathyroidectomy standards, Thyroidectomy standards
- Abstract
In the past decade, the use of intraoperative neural monitoring (IONM) in thyroid and parathyroid surgery has been widely accepted by surgeons as a useful technology for improving laryngeal nerve identification and voice outcomes, facilitating neurophysiological research, educating and training surgeons, and reducing surgical complications and malpractice litigation. Informing patients about IONM is not only good practice and helpful in promoting the efficient use of IONM resources but is indispensable for effective shared decision making between the patient and surgeon. The International Neural Monitoring Study Group (INMSG) feels complete discussion of IONM in the preoperative planning and patient consent process is important in all patients undergoing thyroid and parathyroid surgery. The purpose of this publication is to evaluate the impact of IONM on the informed consent process before thyroid and parathyroid surgery and to review the current INMSG consensus on evidence-based consent. The objective of this consensus statement, which outlines general and specific considerations as well as recommended criteria for informed consent for the use of IONM, is to assist surgeons and patients in the processes of informed consent and shared decision making before thyroid and parathyroid surgery., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Wu, Huang, Randolph, Barczyński, Schneider, Chiang, Silver Karcioglu, Wojtczak, Frattini, Gualniera, Sun, Weber, Angelos, Dralle and Dionigi.)
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- 2021
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40. The utility of preoperative echocardiography in pediatric obstructive sleep apnea.
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Pettitt-Schieber B, Tey CS, Hill R, Vaughn W, Pakanati V, Leu R, and Raol N
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- Adolescent, Child, Child, Preschool, Female, Heart Defects, Congenital diagnosis, Humans, Infant, Male, Severity of Illness Index, Echocardiography standards, Heart Diseases diagnosis, Outcome and Process Assessment, Health Care, Postoperative Complications diagnosis, Preoperative Care standards, Sleep Apnea, Obstructive surgery
- Abstract
Purpose: The purpose of this study was to determine the associations between cardiac function and postoperative adverse events in pediatric patients with obstructive sleep apnea (OSA)., Methods: Patients between birth and 18 years of age diagnosed with OSA between January 1, 2015, and December 31, 2018, who underwent echocardiographic evaluation within 6 months of surgery at a tertiary care children's hospital were evaluated. Exclusion criteria included history of neuromuscular disorders, tracheostomy placement, or a predominance of central apneic events recorded during polysomnography (PSG). Patients were grouped by OSA severity. Chi-squared analysis and logistic regression were utilized to determine associations between demographic characteristics, OSA severity, preoperative echocardiographic abnormalities, and postoperative adverse events., Results: One hundred ten children met inclusion criteria for the study, including 22 with mild OSA, 22 with moderate OSA, and 66 with severe OSA. Race and the presence of congenital heart disease (CHD) were significantly associated with differences in OSA severity. Echocardiographic abnormalities were found in 45 patients, but exclusion of patients with CHD revealed no significant associations with differences in OSA severity. Postoperative adverse events were identified in 18 (16%) patients, and only O
2 saturation nadir was found to be a significant predictor of these complications., Conclusion: Preoperative echocardiogram abnormalities are not commonly found in children with OSA and presence of abnormalities does not predict postoperative adverse events. O2 saturation nadir measured on preoperative PSG is a significant predictor of postoperative adverse events and should be examined as a clinical indicator of OSA severity., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG part of Springer Nature.)- Published
- 2021
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41. Comparison of non-invasive imaging modalities in presurgical evaluation of temporal lobe epilepsy patients: a multicenter study.
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Habibabadi JM, Doroudinia A, Koma AY, Fesharaki SSH, and Aarabi S
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- Adolescent, Adult, Child, Cross-Sectional Studies, Drug Resistant Epilepsy metabolism, Drug Resistant Epilepsy surgery, Epilepsy, Temporal Lobe metabolism, Epilepsy, Temporal Lobe surgery, Female, Humans, Magnetic Resonance Imaging standards, Male, Middle Aged, Positron-Emission Tomography standards, Preoperative Care standards, Young Adult, Drug Resistant Epilepsy diagnostic imaging, Epilepsy, Temporal Lobe diagnostic imaging, Magnetic Resonance Imaging methods, Positron-Emission Tomography methods, Preoperative Care methods
- Abstract
Intractable drug-resistant magnetic resonance imaging (MRI) negative epilepsy in one of the complicated issues in neurology. Epilepsy surgery is beneficial treatment of intractable seizures, but precise localization of epileptogenic zone is a major concern. Thirty-four MRI negative drug-resistant epilepsy patients underwent video electroencephalography (EEG), positron emission tomography (PET) scan, and voxel-based morphometry (VBM) MRI from 2014 to 2019. Then, the findings of PET scan and VBM were compared with semiology and long-term electrophysiology. Cohen's kappa-coefficient (k) test was utilized to measure the agreement between our modalities. Among 34 patients with age ranging from 8 to 49 (mean: 29.00 ± standard deviation: 10.35), 19 were male (55.9%) and 15 were female (44.1%). Twenty-one patients (61.76%) had right temporal, 12 patients (35.3%) had left and one patient had bilateral temporal ictal focus according to video EEG. Inter-rater agreement analysis showed that the kappa index between video EEG and PET scan was of almost acceptable (more than 0.4) and there was poor agreement between video EEG and VBM (kappa index = 0.099). PET is highly concordant with video EEG in temporal lobe epilepsy (TLE) and has a considerable agreement in localizing epileptogenic zone while VBM is less., (© 2020. Belgian Neurological Society.)
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- 2021
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42. Preoperative Management of Gastrointestinal and Pulmonary Medications: Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement.
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Pfeifer KJ, Selzer A, Whinney CM, Rogers B, Naik AS, Regan D, Mendez CE, Urman RD, and Mauck K
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- Gastrointestinal Agents adverse effects, Humans, Perioperative Care methods, Perioperative Care standards, Preoperative Care methods, Respiratory System Agents adverse effects, Gastrointestinal Agents therapeutic use, Preoperative Care standards, Quality Improvement standards, Respiratory System Agents therapeutic use
- Abstract
Perioperative medication management is integral to preoperative optimization but remains challenging because of a paucity of literature guidance. Published recommendations are based on the expert opinion of a small number of authors without collaboration from multiple specialties. The Society for Perioperative Assessment and Quality Improvement (SPAQI) recognized the need for consensus recommendations in this area as well as the unique opportunity for its multidisciplinary membership to fill this void. In a series of articles within this journal, SPAQI provides preoperative medication management guidance based on available literature and expert multidisciplinary consensus. The aim of this consensus statement is to provide practical guidance on the preoperative management of gastrointestinal and pulmonary medications. A panel of experts with anesthesiology, perioperative medicine, hospital medicine, general internal medicine, and medical specialty experience was drawn together and identified the common medications in each of these categories. The authors then used a modified Delphi approach to review the literature and to generate consensus recommendations., (Copyright © 2021 Mayo Foundation for Medical Education and Research. All rights reserved.)
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- 2021
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43. Commentary in response to BMC Urology publication entitled "Infection-related hospitalization following ureteroscopic stone treatment: results from a surgical collaborative".
- Author
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Mayer WA
- Subjects
- Guideline Adherence, Humans, Kidney Calculi urine, Postoperative Complications etiology, Practice Guidelines as Topic, Preoperative Care standards, Research Design, Risk Factors, Standard of Care, Hospitalization statistics & numerical data, Kidney Calculi surgery, Ureteroscopy adverse effects, Urinary Tract Infections etiology
- Abstract
This Commentary is in response to the BMC Urology publication entitled "Infection-related hospitalization following ureteroscopic stone treatment: Results from a surgical collaborative". This study utilized a registry with prospectively recorded standardized data elements named Reducing Operative Complications from Kidney Stones, part of the Michigan Urological Surgery Improvement Collaborative, to identify risk factors of infection-related hospitalization after ureteroscopy for stone treatment. The study included 1817 primary URS procedures for urinary stones in 11 practices in Michigan. They found 43 patients (2.4%) were hospitalized with an infection-related complication and 3 patients died during their hospitalization (0.2% mortality rate). Just over 20% of patients did not have a pre-operative urinalysis or urine culture, representing a deviation from guideline recommendations. Also, in the hospitalized group, none of the 12 patients (27.9%) who had a positive pre-operative urinalysis or urine culture received pre-operative treatment. A multivariable analysis identified higher Charleston Comorbidity Index, history of recurrent urinary tract infection, increasing stone size, intraoperative complications, and fragments left in-situ as independent risk factors for hospitalization from an infection after ureteroscopy. This commentary discusses caveats to the data as well as short-comings of the study. It also reviews more broadly infection after ureteroscopy, includes findings from similar studies, and highlights guideline recommendations to reduce infection risk., (© 2021. The Author(s).)
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- 2021
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44. Optimal duration of preoperative antibiotic treatment prior to ureteroscopic lithotripsy to prevent postoperative systemic inflammatory response syndrome in patients presenting with urolithiasis-induced obstructive acute pyelonephritis.
- Author
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Yoo JW, Lee KS, Chung BH, Kwon SY, Seo YJ, Lee KS, and Koo KC
- Subjects
- Anti-Bacterial Agents therapeutic use, Duration of Therapy, Female, Humans, Male, Middle Aged, Outcome and Process Assessment, Health Care, Preoperative Care methods, Preoperative Care standards, Ureteral Calculi diagnosis, Antibiotic Prophylaxis methods, Cephalosporins therapeutic use, Lithotripsy adverse effects, Lithotripsy methods, Postoperative Complications etiology, Postoperative Complications prevention & control, Pyelonephritis etiology, Pyelonephritis therapy, Systemic Inflammatory Response Syndrome etiology, Systemic Inflammatory Response Syndrome prevention & control, Ureteral Calculi surgery, Ureteral Obstruction diagnosis, Ureteral Obstruction etiology, Ureteral Obstruction surgery, Ureteroscopy adverse effects, Ureteroscopy methods
- Abstract
Purpose: There is no consensus on the optimal duration of preoperative antibiotic treatment prior to ureteroscopic lithotripsy in patients presenting with urolithiasis-induced obstructive acute pyelonephritis (APN). We aimed to identify surgeon-modifiable, preoperative risk factors associated with postoperative systemic inflammatory response syndrome (SIRS) in these patients., Materials and Methods: This multicenter retrospective study evaluated 115 patients who presented with urolithiasis-induced obstructive APN between January 2008 and December 2019. All patients were administered intravenous third-generation cephalosporin until culture sensitivity confirmation or until ureteroscopic lithotripsy. Data were collected for age, sex, diabetes mellitus, performance status, stone features, hydronephrosis grade, preoperative renal collecting system drainage, laboratory data, operative time, and duration of preoperative antibiotic treatment. Sensitivity analysis using Youden's index and logistic regression analysis were used to assess risk factors of postoperative SIRS., Results: Postoperative SIRS was identified in 32 (27.8%) patients. The incidence of postoperative SIRS was higher in patients who received preoperative antibiotic treatment for fewer than 14 days (38.8% vs. 12.5%; p=0.001). Backward variable selection logistic regression analysis revealed maximal stone diameter ≥15 mm, duration of preoperative antibiotic treatment <14 days, and preoperative C-reactive protein (CRP) level ≥6.0 mg/L to be associated with higher risk of postoperative SIRS., Conclusions: Patients with urolithiasis-induced obstructive APN planned for ureteroscopic lithotripsy should be administered at least 14 days of preoperative antibiotic administration and achieve a serum CRP level ≤6.0 mg/L to minimize the risk of postoperative SIRS., Competing Interests: The authors have nothing to disclose., (© The Korean Urological Association, 2021.)
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- 2021
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45. Prevalence, Costs, and Consequences of Low-Value Preprocedural Urinalyses in the US.
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Shenoy ES, Giuriato MA, and Song Z
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- Adult, Communicable Diseases diagnosis, Communicable Diseases epidemiology, Drug Resistance, Microbial drug effects, Female, Guideline Adherence statistics & numerical data, Humans, Male, Practice Guidelines as Topic, Prevalence, United States epidemiology, Anti-Bacterial Agents economics, Anti-Bacterial Agents therapeutic use, Low-Value Care, Medical Overuse economics, Medical Overuse prevention & control, Preoperative Care methods, Preoperative Care standards, Preoperative Care statistics & numerical data, Procedures and Techniques Utilization economics, Procedures and Techniques Utilization statistics & numerical data, Urinalysis economics, Urinalysis methods, Urinalysis statistics & numerical data, Urologic Diseases epidemiology, Urologic Diseases therapy, Urologic Diseases urine
- Published
- 2021
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46. Universal preprocedural SARS-CoV-2 testing protocol within a large healthcare system.
- Author
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Squiers JJ, Ghamande S, Qiu T, Robinson C, Bertschy C, Arroliga AC, and Peters W
- Subjects
- COVID-19 prevention & control, COVID-19 Testing standards, Clinical Protocols, Delivery of Health Care, Humans, Infectious Disease Transmission, Patient-to-Professional prevention & control, Infectious Disease Transmission, Professional-to-Patient prevention & control, Patient Safety, Preoperative Care standards, Texas, COVID-19 diagnosis, COVID-19 transmission, COVID-19 Testing methods, Infectious Disease Transmission, Patient-to-Professional statistics & numerical data, Infectious Disease Transmission, Professional-to-Patient statistics & numerical data, Preoperative Care methods
- Published
- 2021
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47. Clinical practice guideline: evidence, recommendations and algorithm for the preoperative optimization of anemia, hyperglycemia and smoking.
- Author
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Greenberg JA, Zwiep TM, Sadek J, Malcolm JC, Mullen KA, McIsaac DI, Musselman RP, and Moloo H
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- Anemia diagnosis, Humans, Hyperglycemia diagnosis, Algorithms, Anemia therapy, Evidence-Based Medicine standards, Hyperglycemia therapy, Postoperative Complications prevention & control, Practice Guidelines as Topic standards, Preoperative Care standards, Smoking therapy
- Abstract
Preoperative optimization has not been explored comprehensively in the surgical literature, as this responsibility has often been divided among surgery, anesthesia and medicine. We developed an evidence-based clinical practice guideline to summarize existing evidence and present diagnostic and treatment algorithms for use by surgeons caring for patients scheduled to undergo major elective surgery. We focus on 3 common comorbid conditions seen across surgical specialties - anemia, hyperglycemia and smoking - as these conditions increase complication rates in patients undergoing major surgery and can be optimized successfully as soon as 6-8 weeks before surgery. With the ability to address these conditions earlier in the patient journey, surgeons can positively affect patient outcomes. The aim of this guideline is to bring optimization in the preoperative period under the existing umbrella of evidence-based surgical care., Competing Interests: Competing interests: Kerri Mullen is a named inventor of the Ottawa Model for Smoking Cessation, an intellectual property of the University of Ottawa Heart Institute. No other competing interests were declared., (© 2021 CMA Joule Inc. or its licensors.)
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- 2021
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48. Relation of Guideline Adherence to Outcomes in Patients With Asymptomatic Severe Primary Mitral Regurgitation.
- Author
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Tang L, Harris KM, Garberich R, Gössl M, Cavalcante JL, Bradley SM, Ahmed A, Lesser JR, Bae R, Sun B, Mudy K, and Sorajja P
- Subjects
- Aged, Disease Progression, Echocardiography, Female, Follow-Up Studies, Heart Valve Prosthesis Implantation, Humans, Male, Mitral Valve Insufficiency physiopathology, Mitral Valve Insufficiency surgery, Retrospective Studies, Severity of Illness Index, Guideline Adherence, Mitral Valve Insufficiency diagnosis, Preoperative Care standards, Ventricular Function, Left physiology
- Abstract
Current guidelines empirically recommend serial clinical evaluations for asymptomatic patients with severe mitral regurgitation (MR). However, there is a paucity of data on the effectiveness of such monitoring. This study sought to examine the potential benefit of guideline adherence among asymptomatic patients with severe primary MR. Asymptomatic patients with severe primary MR who had been evaluated in the Allina Health system between January 1, 2012 and May 30, 2018 were examined. The medical records were manually reviewed for demographics, comorbidities, echocardiographic data, subsequent interventions, and clinical outcomes. Patients were grouped according to occurrence of guideline adherence, which was defined as a serial clinical evaluation with echocardiography every 12 ± 1 month until mitral valve surgery, or death. Over the study period, 246 patients (67.3 ± 15.5 years, 61.4% men) with severe, asymptomatic primary MR were identified, including 154 patients (62.6%) with and 92 patients (37.4%) without guideline adherence. Overall, there were no differences in demographics, morbidities, MR severity, or left ventricular function between patient adherence groups. During follow-up (40.9; 21.2, 58.3 months), patients with adherence more frequently had surgery or transcatheter therapy performed (64.3% vs 18.5%; p <0.001) and the time to intervention was earlier (13.6 [3.9-22.7] vs 44.2[25.6-57.3] months; p <0.001). Compared to non-adherent patients, those with guideline adherence had a significantly higher five-year survival free from all-cause mortality (92.0% vs 74.3%, p = 0.002), and freedom from death or hospitalization for heart failure (90.1% vs 69.3%, p = 0.001). Adherent patients also had a significantly better survival free from combined endpoint of death, re-hospitalization for heart failure, myocardial infarction, and stroke (84.5% vs 63.2%, p = 0.002). In patients with asymptomatic severe primary MR, guideline adherence with serial evaluations every 12 months or less is associated with earlier therapy and improved long-term outcomes. These data support educational efforts to promote guideline adherence., Competing Interests: Disclosures The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier Inc. All rights reserved.)
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- 2021
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49. Adherence to the European Society of Cardiology/European Society of Anaesthesiology recommendations on preoperative cardiac testing and association with positive results and cardiac events: a cohort study.
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Lurati Buse GAL, Puelacher C, Gualandro DM, Kilinc D, Glarner N, Hidvegi R, Bolliger D, Arslani K, Lampart A, Steiner LA, Kindler C, Wolff T, Mujagic E, Guerke L, and Mueller C
- Subjects
- Algorithms, Clinical Decision-Making, Decision Support Techniques, Heart Diseases etiology, Heart Diseases mortality, Heart Diseases prevention & control, Humans, Predictive Value of Tests, Risk Assessment, Risk Factors, Surgical Procedures, Operative mortality, Treatment Outcome, Anesthesiology standards, Diagnostic Techniques, Cardiovascular standards, Guideline Adherence standards, Heart Diseases diagnosis, Practice Guidelines as Topic standards, Preoperative Care standards, Surgical Procedures, Operative adverse effects
- Abstract
Background: European Society of Cardiology/European Society of Anaesthesiology (ESC/ESA) guidelines inform cardiac workup before noncardiac surgery based on an algorithm. Our primary hypotheses were that there would be associations between (i) the groups stratified according to the algorithms and major adverse cardiac events (MACE), and (ii) over- and underuse of cardiac testing and MACE., Methods: This is a secondary analysis of a multicentre prospective cohort. Major adverse cardiac events were a composite of cardiac death, myocardial infarction, acute heart failure, and life-threatening arrhythmia at 30 days. For each cardiac test, pathological findings were defined a priori. We used multivariable logistic regression to measure associations., Results: We registered 359 MACE at 30 days amongst 6976 patients; classification in a higher-risk group using the ESC/ESA algorithm was associated with 30-day MACE; however, discrimination of the ESC/ESA algorithms for 30-day MACE was modest; area under the curve 0.64 (95% confidence interval: 0.61-0.67). After adjustment for sex, age, and ASA physical status, discrimination was 0.72 (0.70-0.75). Overuse or underuse of cardiac tests were not consistently associated with MACE. There was no independent association between test recommendation class and pathological findings (P=0.14 for stress imaging; P=0.35 for transthoracic echocardiography; P=0.52 for coronary angiography)., Conclusions: Discrimination for MACE using the ESC/ESA guidelines algorithms was limited. Overuse or underuse of cardiac tests was not consistently associated with cardiovascular events. The recommendation class of preoperative cardiac tests did not influence their yield., Clinical Trial Registration: NCT02573532., (Copyright © 2021 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.)
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- 2021
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50. The impact of preoperative vitamin administration on skeletal status following sleeve gastrectomy in young and middle-aged women: a randomized controlled trial.
- Author
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Ben-Porat T, Weiss R, Khalaileh A, Abu Gazala M, Kaluti D, Mintz Y, Sherf-Dagan S, Yackobovitch-Gavan M, Rottenstreich A, Brodie R, Pikarsky AJ, and Elazary R
- Subjects
- Adult, Chi-Square Distribution, Dietary Supplements standards, Dietary Supplements statistics & numerical data, Female, Gastrectomy methods, Gastrectomy statistics & numerical data, Humans, Middle Aged, Preoperative Care methods, Preoperative Care statistics & numerical data, Vitamins therapeutic use, Bone Density drug effects, Gastrectomy adverse effects, Preoperative Care standards, Vitamins administration & dosage
- Abstract
Background: The appropriate strategies to minimize skeletal deterioration following bariatric surgeries are inconclusive. This randomized controlled trial evaluated the effect of preoperative vitamin supplementation on bone mineral density (BMD) and biochemical parameters in females post-sleeve gastrectomy (SG)., Methods: Participants were randomized to a 2-month preoperative treatment with a multivitamin and vitamin D 4000 IU/d (intervention arm) or 1200 IU/d (control arm). Preoperative and 12-month postoperative follow-up evaluations included anthropometrics, biochemical parameters, and dual energy X-ray absorptiometry (DEXA)., Results: Sixty-two females (median age 29.7 years and median BMI 43.4 kg/m
2 ) were recruited, 87% completed the 12-month follow-up. For the intervention and control arms, significant and similar reductions at 12-months post-surgery were observed in BMD of the hip (-6.8 ± 3.7% vs. -6.0 ± 3.6%; P = 0.646) and of the femoral neck (-7.1 ± 5.8% vs. -7.2 ± 5.5%; P = 0.973). For the intervention compared to the control arm, the 25 hydroxyvitamin D (25(OH)D) increment was greater after 2 months treatment, and vitamin D deficiency rates were lower at 3 and 6-months follow-up (P < 0.016). However, at 12-months postoperative, 25(OH)D values and vitamin D deficiency were comparable between the arms (P > 0.339). Predictors for BMD decline in the total hip were the percentage of excess weight-loss, age>50 years, and lower initial BMI (P ≤ 0.003)., Conclusions: SG was associated with a significant decline in BMD of the hip and femoral neck in young and middle-aged women, and was unaffected by preoperative vitamin D supplementation. Females who are peri-menopausal or with greater postoperative weight-loss should be particularly followed for BMD decline., (© 2021. The Author(s), under exclusive licence to Springer Nature Limited.)- Published
- 2021
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